Study finds abuse survivors face barriers to perimenopause care

A qualitative study of 15 women from a UK national survivors’ group found that perimenopause symptoms were tangled up with trauma, mental health, and reluctance to seek help, while primary care responses ranged from useful treatment to dismissal and misdiagnosis.

What the study shows

The paper uses semi-structured interviews and focus groups, analysed thematically, and identifies three themes: confusion over symptoms, medical avoidance, and uneven experiences in primary care. Participants struggled to tell menopause changes apart from mental health conditions, pre-existing illness, or abuse-related trauma, which can make a standard symptom checklist too blunt to be useful.

Inequalities in menopause care persist among ethnic minorities, disabled people, and people experiencing domestic abuse, and menopause symptoms are harder to identify when co-existing conditions or psychosocial stressors are in the picture. The result is a care pathway that can miss both the menopause and the abuse unless clinicians are alert to both.

Why symptoms become hard to read

Perimenopause rarely arrives as one tidy complaint. For women living with a history of abuse, sleep disturbance, low mood, brain fog, body pain, and anxiety can all sit on top of older trauma, ongoing stress, or previous diagnoses, so the complaint that reaches a GP may not look like “menopause” at all. The study’s first theme shows that participants were trying to interpret overlapping changes without a clean way to separate cause from effect.

That is where the usual advice to simply book a GP appointment starts to look thin. The study’s second theme, medical avoidance and barriers to accessing support, shows that advice only works if a consultation feels safe, worthwhile, and emotionally manageable.

What happened in primary care

Some women received helpful treatment, while others felt dismissed or misdiagnosed, including being given antidepressants instead of hormone replacement therapy. The important point is not that antidepressants are never appropriate, but that the study shows how easily menopause care can narrow into a mental health label when the bigger picture is not taken seriously.

The researchers also found missed opportunities for domestic abuse disclosure during menopause consultations. If the menopause appointment is one of the few health contacts a survivor makes, it can become a doorway to support or another missed opportunity. The authors conclude that primary care should integrate domestic abuse screening into menopause consultations and use a holistic, patient-centred approach.

What trauma-informed menopause care would actually require

A trauma-informed model in general practice would mean making space for disclosure, asking about abuse as part of routine menopause care, and recognising that a person may not volunteer safeguarding concerns unless the consultation feels private, unhurried, and non-judgmental. It would also mean training clinicians to hear trauma cues without collapsing everything into anxiety or depression.

It would also mean connecting menopause care to existing domestic abuse infrastructure instead of treating the two issues as separate worlds. IRIS is a specialist domestic abuse training, support, and referral programme for general practices, and NIHR says it is commissioned in 57 areas. The original Health Foundation programme tested educational support for 48 GP practices in Bristol and east London.

IRISi says 80% of women in a violent relationship seek help from health services, often as their first or only point of contact, which makes primary care the place where missed opportunities become visible. If menopause is one of the reasons she shows up, the consultation should be built to catch both symptom burden and safety risk.

The policy backdrop is already there

The Office for National Statistics estimated that 3.8 million people aged 16 and over experienced domestic abuse in England and Wales in the year ending March 2025, including 2.2 million women. The women who may arrive in a menopause clinic carrying abuse-related barriers are part of a very large patient population.

NICE already has two relevant pieces of guidance on the shelf. NG23, its menopause guideline, covers identifying and managing menopause and includes individualised care, identifying perimenopause and menopause, and discussing management options with people aged 40 or over. PH50, its domestic violence and abuse public health guideline, is aimed at identifying, preventing and reducing abuse and includes training for health and social care professionals.

PH50 was last reviewed on 11 July 2024, and NG23 was last updated on 15 April 2026. The hard part is translating that guidance into a GP appointment that can hold menopause symptoms and abuse history in the same room.